=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306568407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVC HEALTH IPA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2022
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4419 DUSTY MEADOW LN
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77479-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-797-0883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14090 SOUTHWEST FWY STE 300
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-3679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-281-3839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. BAO THANG NGOC PHAM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-989-7232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------